Factors influencing time-dependent decannulation after pediatric tracheostomy according to the Kaplan-Meier method

Purpose The aim of this study was to determine whether there were differences in decannulation rates and time to decannulation in children depending on the indication for tracheostomy, age, and maturity at birth. Study design Retrospective chart review and prospective interview by questionnaire. Methods The medical records of 106 pediatric patients (age 0-18 years) tracheostomized between January 1 1999 and January 1 2019 were reviewed. Patients were divided into three different groups depending on the indication for tracheostomy: unsafe airway (37.7%), long-term respiratory dependence (50.9%), or bronchopulmonary toilet for aspirations (11.3%). Results 40 patients were successfully decannulated. The time-dependent decannulation rate after 2 and 5 years was 28.3% and 40.5% for patients with an unsafe airway, 42.4% and 66.8% for patients with long-term respiratory dependence, and 41.7% and 70.8% for patients needing bronchopulmonary toilet, respectively. After 2 and 5 years, patients aged 0-12 months at the time of tracheostomy were decannulated in 13.1% and 50.2% of cases, 1-5-year-olds in 35.3% and 48.2% of cases, 6-10-year-olds in 70% and 70% of cases, and 11-18-year-olds in 66.6% and 66.6% of cases, respectively. However, in a multivariate analysis, prematurity was found to be the only significant unfavorable variable (p = 0.013). Maturely born patients had an odds ratio of 3.87 (95% CI 1.32-11.33) for successful decannulation. This effect was present only in the first 5 years of life. Conclusion Factors indicating problems with decannulation are an unsafe airway, a young age at the time of tracheostomy, and prematurity at birth.